Aim: to assess perinatal maternal and fetal outcomes in women with iron deficiency anemia (IDA), based on the therapeutic approach and timing.

   Materials and Methods. A non-interventional cohort study was conducted to assess the effectiveness of treatment with intravenously administered iron preparation in 65 pregnant women diagnosed with moderate-to-severe IDA: at 20–40 weeks of gestation 32 patients received treatment with intravenous iron (main group), 33 women received oral therapy (comparison group). Comparatively analyzed pregnancy course and outcomes based on the therapy protocol were assessed. At the gestational age of 20–23 and 35–40 weeks, clinical data, routine hemogram parameters (hemoglobin level, hematocrit, erythrocyte concentration, erythrocyte indices, total iron binding capacity), serum ferritin-related iron balance, blood viscosity indices within high and low shear rates were investigated.

   Results. The groups turned out to be comparable in terms of the major indicators – age, parity, the time of anemia diagnosis, and the average hemoglobin level at the follow-up onset. In main group, after a course of intravenous administration of iron carboxymaltosate, the average hemoglobin level increased from 82.3 ± 6.1 g/L to 98.8 ± 6.8 g/L, for ferritin level – from 9.45 ± 0.28 µg/L to 28.35 ± 0.21 µg/L, total iron binding capacity decreased from 87.5 ± 1.72 mmol/L to 69.8 ± 1.03 mmol/L. In comparison group, the dynamics of indicators was markedly lower: the average hemoglobin level decreased from 87.5 ± 6.4 g/L to 84.5 ± 8.1 g/L, ferritin level decreased from 11.26 ± 0.12 µg/L to 9.47 ± 0.56 µg/L, whereas total iron binding capacity increased from 88.4 ± 0.18 µmol/L to 91.2 ± 1.2 µmol /L. Inter-group perinatal complications differed as well: in comparison vs. main group more often were observed untimely discharge of amniotic fluid (54.5 % vs. 28.1 %; p = 0.031), injuries to the soft tissues of the birth canal (28.1 % vs. 9.1 %; p = 0.048), obstetric bleeding (21.2% vs. 3.1%; p = 0.027), post-delivery infectious complications (24.2 % vs. 6.25 %; p = 0.045). Moreover, in comparison vs. main group there was a higher percentage of neonatal pathologies: fetal growth retardation (39.4 % vs. 15.6 %; p = 0.033), asphyxia at birth (45.5 % vs. 18.8 %; p = 0.015), hemorrhagic disorders (24.2 % vs. 6.3 %; p = 0.045). It was found that IDA was accompanied by deteriorated blood rheological properties manifested as increased viscosity at low shear rates (main group: at a rate of 3 s–1, the viscosity of whole blood was 6.63 ± 0.17 cPs, comparison group – 6.6 ± 0.13 cPs) in contrast to healthy pregnant women (5.54 ± 0.28 cPs) (p < 0.05). After intravenous iron therapy, blood viscosity at a shear rate of 3 s^–1 decreased in main group to 5.68 ± 0.23 cPs and did not differ from control (p > 0.05). At the same time, blood viscosity in patients treated with oral drugs had no positive effect and remained at the level of 6.27 ± 0.12 cPs.

   Conclusion. The use of intravenous iron carboxymaltosate in pregnant women in the second trimester is an effective approach to treat anemia that alleviates rate of perinatal complications and has a beneficial effect on blood rheological properties.

   Aim: to assess the molecular mechanisms in developing various clinical phenotypes of preeclampsia (PE) by analyzing specific placental tissue transcriptome patterns.

   Materials and Methods. The prospective observational comparative study in parallel groups enrolled 43 pregnant women divided into 2 groups: main group – 23 pregnant women with diagnosed PE and control group – 20 apparently healthy women with uncomplicated pregnancy course, delivery and the postpartum period. To examine PE phenotypic features, the main group of pregnant women with PE was subsequently divided into 2 subgroups according to the date of pathology onset: early (n = 10) and late (n = 13) PE. Using the whole-genome next-generation sequencing (NGS), a comparative analysis of altered 18 microRNA level in placental tissue was carried out.

   Results. Pregnant women with early PE compared to the control group were characterized by significantly low expression level for hsa-miR-656-3p (p < 0.001), hsa-miR-323a-5p (p = 0.017), hsa-miR-519c-3p (p = 0.019), hsa-let-7i-5p (p = 0.019), hsa-miR-433-3p (p = 0.019), hsa-let-7g-5p (p = 0.030), hsa-miR-214-5p (p = 0.030), hsa-miR-27a-5p (p = 0.031), hsa-miR-339-5p (p = 0.041), hsa-miR-524-5p (p = 0.045), hsa-miR-1283 (p = 0.049) and high expression for hsa-miR-151a-5p (p = 0.007), hsa-miR-4521 (p = 0.018), hsa-miR-30d-5p (p = 0.026), hsa-miR-548l (p = 0.027), hsa-miR-133b (p = 0.034), hsa-miR-424-5p (p = 0.042), hsa-miR-211-5p (p = 0.049). Patients with late PE had significantly decreased expression for hsa-miR-656-3p (p = 0.050) and
hsa-miR-574-3p (p = 0.017) as well as a significantly higher for hsa-miR-211-5p (p = 0.001) compared to the control group. Subgroup of women with early vs. late onset PE was characterized by significantly decreased expression level for hsa-miR-323-5p (p = 0.007) and overexpressed hsa-miR-30d-5p (p = 0.002), hsa-miR-5481 (p = 0.027).

   Conclusion. The noted multidirectional expression for some microRNAs in subgroups of PE patients confirms the validity for stratification of such pathology based on two distinct phenotypic manifestations (early and late forms) and indicates the existence of different pathophysiological vectors in PE formation.

   Aim: to develop enzyme-linked immunosorbent tests for assessing the antiphospholipid syndrome (APS) markers and determine prevalence of three antiphospholipid antibody (aPL) types at different COVID-19 stages.

   Materials and Methods. A comparative longitudinal controlled study was conducted by examining 120 subjects with COVID-19 diagnosis verified by reverse transcription polymerase chain reaction. Donor serum samples collected before November 2019 were used as a control group. The laboratory study included measurement of IgA, IgM and IgG against β2-glycoprotein 1 (β2-GP1), cardiolipin, phosphatidylserine-prothrombin complex (PS-PT) by using domestically produced test systems based on indirect two-step enzyme-linked immunosorbent assay.

   Results. Validation of the developed experimental tests was carried out in comparison with foreign commercial analogues in accordance with international standards. Alternative antigenic targets for effective diagnosis of antibodies against β2-GP1 were studied. Analyzing rate of aPL in patients at different COVID-19 stages showed that in acute vs. convalescence stage it was higher by 1.3-fold (81.7 and 65.0 %, respectively). The first rank detection place was assigned to IgG against β2-GP1, cardiolipin and PS-PT, the second – IgM against cardiolipin. The profile of the detected antibodies changed at various COVID-19 stages driven by time frame elapsed from the moment of diagnosis.

   Conclusion. Recombinant constructs are created and analytical conditions are optimized for determining various aPL types. It was shown that along with other viral infections, COVID-19 triggers autoantibody production demonstrating that 54.2 % individuals infected with SARS-CoV-2 were positive at least for one autoantibody type. The majority of such virus-associated aPL are presumably transiently positive.

   Aim: to assess adaptive hemostasis changes in multiple dichorionic pregnancy after in vitro fertilization (IVF).

   Materials and Methods. A prospective observational randomized controlled trial was conducted by examining 58 and 46 pregnant women with multiple dichorionic diamniotic twins resulting from applying assisted reproductive technologies (ART) and spontaneous delivery (comparison group), respectively. Hemostasis parameters were studied as follows: activated partial thromboplastin time (APTT), prothrombin time (PT), thrombin time (TT), fibrinogen, antithrombin, protein C, protein S, functions of protein С (РrоС Global test), D-dimer, platelet aggregation with adenosine-5-diphosphate (ADP), ristocetin, and collagen.

   Results. A high coagulation potential was revealed, more prominent after using ART (p < 0.05). Fibrinogen level gradually increased while gestation age increased, whereas APTT, PT and TT level decreased. In the group with natural conception, fibrinogen increased by 22 % in the second trimester, reaching 4.5 g/L (95 % CI = 4,2–4,8) and by 6 % in the third trimester, reaching 4.8 g/L (95 % CI = 4,3–5,4), whereas in the IVF group – by 26 %, reaching 5.3 g/L (95 % CI = 4,7–5,6) and by 21 %, reaching (6.5 g/L; 95 % CI = 5,2–6,8) in relevant trimester of pregnancy, respectively. Antithrombin level was lower in IVF patients – 76.8 % (95 % CI = 72.6 – 81.0) in the second trimester, reaching 70.6 % (95 % CI = 64.8–76.4) in the third trimester (p < 0.001). Protein C level did not differ significantly between groups and was low within the reference range. The aggregatogram demonstrated a high platelet hemostatic potential in IVF patients (p < 0.05) as early as in the first trimester: ADP-induced aggregation – 68.3 % (95 % CI = 62.9–73.7), ristocetin-induced aggregation – 53.1 % (95 % = CI 48.7–58.5), collagen-induced aggregation – 58.4 % (95 % CI = 52.1–64.7). In the third trimester, both platelet aggregation and functional activity (ADP-induced aggregation – 64.5 % [95 % CI = 59.3–69.7], ristocetin-induced aggregation – 68.4 % [95 % CI = 63.2–73.6], collagen-induced aggregation – 50.7 % [95 % CI = 44.3–57.1]; p < 0.05) and D-dimer level persistently increased, also more prominently in the IVF group (1.60 ± 0.46 ng/ml; p < 0.05).

   Conclusion. Gestational adaptation in induced multiple pregnancies is at high risk of breach in compensatory mechanisms and requires monitoring for timely detection of decompensation signs and their correction to prolong pregnancy till optimal delivery time frame.

   Introduction. In obstetrics, hypertensive disorders of pregnancy (HDP) including preeclampsia (РЕ) are one of the primary causes resulting in critical cases and maternal mortality. HDP prediction is a milestone that allows preventing complications as well as reducing the number of most common relevant complications of pregnancy. Existing algorithms that predict PE risk distribute the risks in such a way that a considerable number of patients fall into the category of false negative results, and, consequently, receive no timely prevention and proper follow-up. In particular, this cohort usually consists of patients with borderline high risks, who may be designated as a medium risk group or located in a “gray” zone.

   Aim: to develop a prognostic model for risk stratification in female patients with borderline to high developing PE risk based on combined first-trimester screening.

   Materials and Methods. A prospective comparative study included 1089 female patients who underwent a combined screening at 11–14 weeks of gestation. Group 1 consisted of female patients at high РЕ risk (1:100 and greater), while female patients at moderate risk (1:101–1:250) and low risk (below 1:250) were included into Group 2 and Group 3, respectively. All pregnant women underwent examination including assessed anamnestic, general clinical and laboratory data, mean blood pressure (BP), uterine artery pulsatility index, serum level of human chorionic gonadotropin beta-subunits (β-hCG), placental growth factor (PlGF), pregnancy-associated plasma protein-A (PAPP-A).

   Results. An impact of various factors on risk of developing hypertensive disorders in pregnancy was assessed by binary logistic regression by identifying most significant among them and generating a statistical prediction model – the prognostic index of hypertensive disorders in pregnancy. The latter included: obstetric history, body mass index, PlGF, mean ВР, and alanine aminotransferase level. The sensitivity and specificity comprised 91.2 and 53.6 %, respectively, and the method effectiveness
was 81.8 %.

   Conclusion. The method proposed for HDP prediction is a second-line approach that may be used in clinical practice to stratify patients with borderline high risk of developing PE.

   Introduction. More than 13 annual million deaths are caused by environmental pollutants worldwide. Urbanization, population growth, industrialization and globalization affect our lives both positively and negatively. Women can become lead exposed through occupational and environmental sources. Once lead enters the body, it is mainly deposited in diverse organs: brain, kidneys, liver and bones. The body stores lead mainly in the bones, where it accumulates over time that may be further released into the bloodstream during pregnancy, thus posing a threat to growing fetus.

   Aim: to examine a lead impact on newborn hematological parameters during perinatal period.

   Materials and Methods. A retrospective cohort study with 306 pregnant women and paired newborns was carried out. Peripheral blood lead level (BLL) in pregnant and postpartum women was analyzed by using the atomic-absorption spectrophotometry method. Blood specimens were collected for analysis in the third trimester of pregnancy. Newborns hemoglobin concentration (mean corpuscular hemoglobin concentration, MCHC) in erythrocytes was also assessed.

   Results. We have detected a statistically significant decrease of MCHC in babies born to mothers with BLL > 0.24 µmol/L vs. BLL < 0.24 µmol/L. This difference may indicate a decline in hemoglobin fetal production caused by lead intoxication.

   Conclusion. Study corroborates an idea that pregnant women with occupational or environmental lead exposure should be monitored for BLL, which should not exceed 0.24 µmol/L during pregnancy.

   Magnesium is an important cofactor for metabolic reactions involving more than 300 enzymes, regulating a series of fundamental processes, such as myocardial contraction and blood pressure control, glucose regulation, participation in neuromuscular transmission. The prevalence of magnesium deficiency in various cohorts of fertile age women comprises up to 73.8 %. In clinical studies it was demonstrated that magnesium deficiency is associated with diseases and states such as dysmenorrhea, premenstrual syndrome (PMS), polycystic ovary syndrome (POS), climacteric syndrome, osteoporosis, use of combined oral contraceptives (COCs) and menopausal hormone therapy (MHT). Magnesium supplementation in combination with basic therapy can positively affect course and outcome of such pathologies. Magnesium organic salts could be used for countering magnesium deficiency. Among such agents, magnesium citrate has some advantage used in combination with pyridoxine (vitamin B₆) providing additional effects. Health care professionals should be guided by the criteria for Mg-containing preparation selection, defined by the Russian Society of Obstetricians and Gynecologists (RSOG).

   Introduction. Vulvovaginal candidiasis is an extremely common pathology of the female genital organs, leading to a long-term recurrent course and multiple complications. Although currently it is widely known about developing antibiotic resistance of bacterial pathogens, it is necessary to remember about similar phenomenon observed in other groups of infectious agents. In this regard, fungal infection also requires development of new therapeutic techniques and medicinal antifungal drugs, such as ibrexafungerp.

   Aim: to analyze available publications revealing the mechanism of action, efficacy, antifungal spectrum and results of clinical trials for a new oral antifungal drug ibrexafungerp.

   Materials and Methods. A search for publications in the electronic databases PubMed, eLibrary and ClinicalTrials.gov, published over the last 25 years was conducted using the following keywords in Russian and English: “candidiasis”, “vulvovaginal candidiasis”, “antifungal drugs”, “ibrexafungerp”, “clinical trials”, “mechanism of action”. Articles were assessed according to PRISMA guidelines. The titles and abstracts of identified publications were independently reviewed to retrieve relevant full text studies. After the selection procedure, 46 articles were included in the review.

   Results. This review provides information on the creation of the drug ibrexafungerp, its mechanism of action, the activity against a relatively wide range of pathogens, as well as the results from 13 ongoing and completed clinical trials in patients with fungal infection.

   Conclusion. The analysis of ibrexafungerp-related clinical studies showed its good oral bioavailability, high antifungal efficacy, so that its one-day dosage may further eliminate a need for unnecessarily long hospitalization and complex dosing schedules, thereby increasing adherence to therapy and odds for treatment success.

   Preterm delivery (PD) is a global public health problem, being the leading cause of perinatal morbidity and mortality in many countries. Despite numerous studies on the etiology of this condition, PD incidence has been increasing annually, and about 15 million infants are born prematurely (before the week 37 of gestation) worldwide. One of the main risk factors for PD is isthmic-cervical incompetence (ICI), which leads to microbial invasion of the amniotic cavity, prolapse of the fetal bladder, premature discharge of amniotic fluid and PD. Currently, several methods for ICI prevention and treatment are available: conservative (use of progesterone, obstetric pessary) and surgical (transvaginal cerclage and transabdominal cerclage).

   Introduction. Obesity is a worldwide problem at epidemic scale. Bariatric surgery (BS) is the most effective method to treat morbid obesity characterized by long-term and positive effects on concomitant diseases. However, the effect of BS on female reproductive health has not been sufficiently studied to date, which makes relevant to conduct further investigations in this field.

   Aim: to summarize research data assessing BS effect on female reproductive health.

   Materials and Methods. There was conducted a search for publications in the electronic databases PubMed, eLibrary and Google Scholar to identify the following keywords and their combinations in Russian and English: "bariatric surgery", "reproductive health", "sex hormones", "pregnancy", "menstrual cycle", "fetal", "neonatal". The evaluation of the articles was carried out in accordance with the PRISMA recommendations. Based on search data, 868 publications from PubMed, 83 publications from eLibrary and 74 publications from Google Scholar were retrieved. After the selection procedure, 79 articles were included in the review.

   Results. To date, the data regarding the long-term BS effects on improved obesity-related endocrine disorders remain insufficient. It is better to recommend long-acting reversible contraceptives such as intrauterine device, to post-BS patients. Women with BS history should have a continuous comprehensive nutritional assessment as well as blood macronutrients and trace elements monitoring before, during and after pregnancy. Recognizing potential complications associated with BS in the anamnesis and timely seeking specialized medical aid or timely transfer of a patient to a specialized medical facility may improve pregnancy outcomes for a mother and paired newborn.

   Conclusion. While making decision to perform BS, it is necessary to fully understand its impact on female reproductive health, assess patients' reproductive intentions and fulfill health education obligations. All patients of childbearing age who are candidates for BS should participate in a joint decision-making dialogue on BS-related risks and benefits for reproductive health, which should be supported by extensive multidisciplinary work involving obstetricians, gynecologists, endocrinologists, psychologists and representatives of other medical specialties. To date, the data regarding the BS-related effects on pregnant women are heterogeneous, which requires additional investigations in this field.

   What events in pregnant woman underlie twins formation? What do zygosity, chorionicity and amnionicity depend on? It seems that the answer is very clear. As early as in 1955, the works by G.W. Corner were published, which served as the basis for proposing the traditional model of twins formation, still remains widely acknowledged. But whether is everything so obvious? In order to answer this question, it is necessary to go back to the roots and understand of how the overall idea about fertilization and formation of multiple pregnancies has evolved since the XVII century till the present time.

   Here, we describe the historical aspects of Nestor Maksimovich Maksimovich-Ambodik life and scientific work, as well as describe his contribution to the formation and development of obstetrics and gynecology in the Russian Empire.